Republicans see political necessity in health care effort

It's divisive and difficult, but the Republican drive to erase the Obama health care overhaul has gotten a huge boost from one of Washington's perennial incentives: Political necessity.

In the two months since Senate Republicans lost their initial attempt to scuttle President Barack Obama's statute, there's fresh evidence GOP voters are adamant that the party achieve its long-promised goal of dismantling that law. This includes conservative firebrand Roy Moore forcing a GOP primary runoff against Sen. Luther Strange, R-Ala., who's backed by President Donald Trump, and lots of money, plus credible primary challenges facing Republican Sens. Jeff Flake of Arizona and Nevada's Dean Heller.

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"Republicans campaigned on this so often that we have a responsibility to carry out what you said in the campaign. And that's as pretty much as much of a reason as the substance of the bill" to support it, Sen. Charles Grassley, R-Iowa, told Iowa reporters in a conference call Wednesday.

"That base is so insistent. You made this promise, stick to it, and you'll be penalized if you don't," said Bill Hoagland, a former top Senate GOP aide and health policy expert.

GOP Sens. Bill Cassidy of Louisiana and South Carolina's Lindsey Graham have spent weeks concocting and selling the party's new approach to scrapping Obama's law. They say their proposal, shifting money and decision-making from Washington to the states, nearly has the votes it would need in a showdown expected next week, a deadline that's focused the party on making a final run at the issue.

Graham and Cassidy would end Obama's requirement that most people buy health coverage and larger employers offer it to workers. It would let insurers charge higher premiums to seriously ill customers and cut Medicaid, the health insurance program for the poor, over time. Money from the law's Medicaid expansion and cost-reductions it provides lower-earning people would be folded into block grants dispersed to states —totaling $1.2 trillion over seven years — with few federal strings attached.

The new package has clear appeal to most Republicans. It would wed the party's oft-repeated goals of uprooting Obama's law and shipping more power and plenty of money back home.

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"We have ONE LAST CHANCE to repeal and replace the most intrusive, overbearing health care law in the history of our country," Cassidy emailed supporters Wednesday.

Republicans commanding the Senate by a 52-48 margin must stage the vote before Sept. 30, when special protections expire that have shielded the measure from needing 60 votes to pass. Three GOP defections would sink the measure because of solid Democratic opposition.

So far, conservative Sen. Rand Paul, R-Ky., has said he'll oppose the bill because it doesn't abolish enough of Obama's 2010 law. Sen. Susan Collins, R-Maine, has cited concerns including the measure's Medicaid cuts and seems a likely no, while noncommittal senators include Lisa Murkowski of Alaska and Arizona's John McCain.

That's not good enough for many conservatives. In a fundraising email, tea party leader Jenny Beth Martin said some party moderates "have betrayed their promises and utterly failed to fully repeal Obamacare. This is not acceptable."

More agonizingly for Republicans, Trump is back on the Twitter warpath. He tweeted Wednesday that he hopes Republicans will "fulfill their promise to Repeal & Replace Obamacare" and took special aim at Paul, a rival for last year's GOP presidential nomination.

"Rand Paul is a friend of mine but he is such a negative force when it comes to fixing healthcare," Trump wrote.

Trump used the platform to repeatedly savage Senate Majority Leader Mitch McConnell, R-Ky., after the effort's July collapse. With nearly 39 million followers, plenty of Republicans would rather not be his next target.

"They're scared to death of a promise they may not keep to the Republican primary base," said Sen. Chris Murphy, D-Conn.

Some Republicans have juxtaposed the new bill with last week's unveiling by Sen. Bernie Sanders, I-Vt., of a measure embodying a liberal dream of government-run health insurance, a dramatic reshaping of the country's health care system. Graham says the contrast — "socialism versus federalism" — has helped him fire up conservatives.

"It was a marriage of a desire for the base not to quit fighting and a new proposal that makes us want to fight more," Graham said in an interview. "The timing, I couldn't have scripted this."

Taking it one step further, Sen. John Kennedy, R-La., said he plans to propose an amendment that would bar states from using their block grants to set up state-run insurance systems. Analysts from both parties say such a threat is implausible because the GOP bill wouldn't give states enough money to do that.

"I've heard the argument that it's impossible. So what's the harm in putting it in," Kennedy said to reporters.

Others discount the impact of using Sanders' bill to drum up support for the Republican legislation. Wavering senators are likelier to base their decision on their views of how the bill will affect home-state constituents and its reception from local GOP officials and voters.